Steve Andreas > Articles > Placebos and Antidepressant Drugs

Placebos and Antidepressant Drugs

First, here are some very interesting findings in relation to placebos:

“Asthmatic patients have been shown to exhibit bronchoconstriction after inhaling a placebo described as a bronchoconstrictor and brochodilation after inhaling a placebo described as a bronchodilator” (Luparello, Lyons, Bleeker, & McFadden, 1968; McFadden, Luparello, Lons, & Bleecker, 1969; Neild & Cameron, 1985; Spector, Luparello, Kopetzky, Souhrada, & Kinsman, 1976).

“Placebo morphine is considerably more effective than placebo Darvon, which in turn is more effective than placebo aspirin (Evans, 1974). In each case, the placebo is about half as effective as the pharmacologically active drug. Similarly, placebos produce more pain relief when given after a more potent drug than they do when given after a less potent drug (Kantor, Sunshine, Laska, Meisner, & Hopper, 1966).” Thus, the effectiveness of a placebo pain reliever varies as a function of its believed effectiveness.

"Placebo and active analgesics are more effective when presented with a well-known brand name (Branthwaite & Cooper, 1981).”

“Placebo injections are more effective than placebo pills (de Craen, Tijssen, de Gans, Kleijnen, 2000).”

“The color of a placebo can influence its effects (reviewed in de Craen, Roos, de Vries, & Kleijnen, 1996). When administered without information about whether they are stimulants or depressives, blue placebo pills produce depressant effects, whereas red placebos induce stimulant effects (Blackwell, Bloomfield, & Buncher, 1972). Patients report falling asleep significantly more quickly after taking a blue capsule than after taking an orange capsule (Luchelli, Cattaneo, & Zattoni, 1978). Red placebos seem to be more effective pain relievers than white, blue, or green placebos (Huskisson, 1974; Nagao, Komia, Kuroanagi, Minaba, & Susa, 1968).”

"Finally, the magnitude of the placebo response has been shown to vary as a function of the dose that the person is asked to consume (de Craen, Moerman, Heisterkamp, Tytgat, Tijssen, & Kleijnen 1999; Kirsch & Weixel, 1988).”

A wide variety of studies over the years has shown that the rates of positive responses to placebos have been increasing over the years (Probably as a result of better experimental design, including active placebos that provide a detectable response unrelated to the problem, and double-blind studies that the subjects cannot penetrate). As one commentator remarked, “The increasing effectiveness of placebos raises the bar toward an impracticably high level for any treatment to demonstrate its effectiveness.” (Perhaps more research should go into designing especially powerful placebos, rather than psychoactive drugs.)

Antidepressants

“The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration.”

Abstract (quoted from the article) ©2002 American Psychological Association.

“This article reports an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the 6 most widely prescribed antidepressants approved between 1987 and 1999: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), nefazodone (Serzone), and citalopram (Celexa). These represent all but one of the selective serotonin reuptake inhibitors (SSRI) approved during the study period.”

“Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale. Improvement at the highest doses of medication was not different from improvement at the lowest doses. The proportion of the drug response duplicated by placebo was significantly greater with observed cases (OC) data than with last observation carried forward (LOCF) data. If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants.”

In shorthand, the antidepressants were found to be only very slightly better than the placebo control group (and the placebos were NOT designed for maximum effectiveness as described at the beginning of this summary!). This confirms what many of us have long suspected--that the drug companies are getting rich on drugs that have only minimal effectiveness. And if the drugs are only minimally effective, the dangers of stopping the drugs are probably also minimal, despite many warnings to the contrary. Still, someone using such drugs would be wise to taper off these drugs slowly, just to be safe.